Provider Demographics
NPI:1801185707
Name:CAPE FEAR VALLEY CHIROPRACTIC GROUP, PC
Entity type:Organization
Organization Name:CAPE FEAR VALLEY CHIROPRACTIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAXTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:PASCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-476-2225
Mailing Address - Street 1:4624 PINE NEEDLE CT
Mailing Address - Street 2:4624 PINE NEEDLE CT.
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2463
Mailing Address - Country:US
Mailing Address - Phone:910-476-2225
Mailing Address - Fax:206-426-6337
Practice Address - Street 1:4624 PINE NEEDLE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2463
Practice Address - Country:US
Practice Address - Phone:910-476-2225
Practice Address - Fax:206-426-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922303817OtherNPI